Medical error: purchase of hospitals by companies increases rates – 01/05/2024 – Health

The rate of serious medical complications has increased in hospitals [dos Estados Unidos] after being acquired by private equity investment firms [capital privado, também conhecido como venture capital]according to a major study on the effects of these acquisitions on patient care in recent years.

The study published in JAMA (Journal of the American Medical Association) found that in the three years after a private equity fund purchased a hospital, adverse events, including surgical infections and pressure ulcers, increased by 25% among Medicare patients compared with similar hospitals that were not purchased by these investors.

Researchers reported a nearly 38% increase in central line infections, a dangerous type of infection that medical authorities say should never occur, and a 27% increase in patient falls during their hospital stay.

“We were not surprised by the indication,” says Sneha Kannan, a health researcher and physician in the division of pulmonary and critical care at Massachusetts General Hospital, who was the paper’s lead author. “I will say we were surprised by how strong it was.”

Although the researchers found a significant increase in medical errors, they also observed a slight decrease (almost 5%) in the rate of patients who died during their hospital stay. They believe other changes, such as healthier patients being admitted to hospitals, could explain this drop. After 30 days of patients’ discharge, there was no significant difference in mortality rates between hospitals.

Other researchers who reviewed the study said that while it did not provide a complete picture of the effects of private equity, it raised important questions about the quality of care in hospitals that had been acquired by private equity owners.

“This is important because it’s the first evidence that strongly suggests there’s a quality problem when private equity takes over,” says Ashish Jha, director of Brown University’s School of Public Health, who has also studied hospital safety.

Over the past two decades, private equity firms have become major players in healthcare, buying not only hospitals but also a growing number of nursing homes, doctor’s offices and home care companies.

Companies pool money from institutional investors and individuals to form investment funds, often buying hospitals and other entities through high levels of debt, with the aim of reselling them within a few years. A separate recent study suggested that companies were consolidating groups of doctors in certain local markets, which could lead to higher prices.

So far, these companies own a small share of U.S. hospitals, although the numbers are difficult to measure because the transactions are not always public.

Several media reports showed that some of the acquired hospitals were forced to close due to financial difficulties, and some were subject to regulatory scrutiny due to quality issues. But these examples are not necessarily typical.

“The private equity industry plays an essential role in providing local hospitals with the capital they need to improve patient care, expand access and drive innovation,” says Drew Maloney, CEO of the American Investment Council, a trade group in sector. “This research does not reflect private equity’s full record in strengthening healthcare across the country.”

The industry has come under scrutiny recently. This month, the Senate Budget Committee began a bipartisan investigation into private equity purchases of hospitals. And bills from several Democrats in Congress have pushed for more public disclosure of private equity deals in health care and for broader reforms on how companies can acquire companies and turn a profit.

Several studies have examined the financial effects of private equity firms on hospitals. The new paper, which examines 51 hospitals between 2009 and 2019, provides new evidence that these changes can result in more dangerous conditions for patients. The researchers, who also include Zirui Song of Harvard and Joseph Dov Bruch of the University of Chicago, received funding from Arnold Ventures, a group that supports a wide range of health research and has been critical of the private equity industry.

Previous research found that patients were less likely to die after visiting a private equity-backed hospital. But the researchers said they wanted to focus their study on specific measures, such as medical errors, that more directly reflect care in a hospital, rather than patient deaths, which are more likely to be influenced by the health status of patients entering the hospital. hospital.

The researchers examined a range of errors that Medicare tracks and encourages hospitals to minimize. Hospitals with high levels of some of these problems — such as central line infections — must pay financial penalties to the government. Although not all errors occurred frequently enough to be measured accurately, and complications occurred rarely overall, all eight individual measures studied in the paper worsened in hospitals acquired by private equity funds.

Rates of these complications have generally been declining for about 15 years, as hospitals work to reduce them and best practices for preventing them become more widespread.

“These are preventable adverse events that everyone thinks shouldn’t happen in hospitals,” says David Blumenthal, former president of the Commonwealth Fund, a nonprofit health research group, which reviewed the study.

Some private equity owners may be overly eager to reduce costs, leading to a decline in the quality of care, he says. “It’s about investment style,” he says. “It’s about aggressiveness and the short-term profits and return on investment that are sought.” In cases where they don’t follow that strategy, private equity can be positive, adds Blumenthal: “It brings capital. It brings innovation.”